This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, February 15, 2014

Weekly Overseas Health IT Links - 15th February, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Leanne Larson, global head of observational research at clinical research organization PAREXEL International, explains the expanded knowledge base that electronic health records data can bring to the drug development and market access processes:

Bringing a biopharmaceutical product to market in today’s rapidly evolving healthcare system is a complex process. In addition to the purely scientific challenge of developing new and innovative treatments for diseases of great complexity, gaining broad market access for these products demands answers far beyond those offered by traditional clinical trial data. Yet broad market and patient access is the ultimate goal – the only way to truly realize the promise offered by these new and often ground-breaking therapies.

Growing cost pressures in healthcare have dramatically shifted reimbursement and market-access decisions globally, and have altered the data needed to support these decisions. As these newer requirements take shape, payors have begun to draw a line in the sand – paying only for “what works.” Many payors, in fact, are now entering into risk-sharing agreements with pharmaceutical companies, reimbursing only for drugs that produce measurable improvements in patient health. (Groves, et al. 2013)

There’s little arguing that drastic improvement to healthcare data interoperability is necessary. It’s not just electronic health records, either, but also the range of technologies spanning from personal medical devices to massive information systems.

Health networks and physician practices have the most to gain from an interoperable ecosystem and, it follows, the most to lose if it doesn’t go right.

But one could argue that American patients and taxpayers stand to gain or lose just as much — especially the next generation of patients and taxpayers, the kids, tweens, teens and 20-somethings who for the most part have not known a world without the benefits and efficiency of the Internet and a laptop, tablet or smartphone.

The U.S. healthcare system isn't a catastrophe like Hurricane Katrina, but it's a slow boil, Karen DeSalvo, National Coordinator for Health IT, said Thursday during Health Care Innovation Day in Washington, D.C.

"The pain is greater and greater, breaking the bank for many Americans," DeSalvo (pictured) said to open the event, hosted by West Health Institute and the Office of the National Coordinator for Health IT.

The CMS is extending the deadline for physicians and other eligible professionals to attest to meaningful use for the Medicare EHR incentive program for the 2013 reporting year and is offering some hospitals a second chance at receiving payment—as well as possible relief from the program's 2015 penalties for failing to comply in 2013.

The new deadline for physicians is 11:59 p.m. March 31, pushed back from Feb. 28. The criteria still must have been met by Dec. 31, 2013, the end of the reporting period for the incentive payments.

“This extension will allow more time for providers to submit their meaningful-use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment,” the CMS said in a news release.

New roles signal new realities and priorities as hospital information technology changes.

The many health care reform initiatives underway are forcing hospital information technology and information management departments to evolve and titles to change. The new names are more than cosmetic, heralding a shift in leadership roles to meet new realities and priorities.

Shane Pilcher, vice president of Stoltenberg Consulting in Bethel Park, Pa., reports seeing expansions of IT departmental functions and, concurrently, a greater role for chief information officers in recent years. "It's becoming more for helping the organization achieve organizational and strategic goals, not just a business unit," Pilcher says.

Rita Bowen, senior vice president of health information management and privacy officer at HealthPort, a Chattanooga, Tenn.-based seller of health care audit management and tracking technology, says health IT departments really should already be profit centers rather than cost centers for health care providers due to revenue-cycle management improving cash flow and from analytics helping on both the financial and clinical sides of the business.

Neil Paul wonders why it is so hard to get information out of GP systems, and whether the new GP Systems of Choice framework will generate some much-needed changes.

5 February 2014

The idea of breaking banks into their separate components is in the news at the moment.

Now, I’m not expert on banking, so I don’t really have an opinion on this. But it has made me think about the broader issue of whether one company should be allowed to try to do everything in its sector, or whether it should it be broken up if it gets too big.

One argument for size is that the profitable side of a company might keep a non-profitable side going in lean years; and there are numerous companies where only one part makes a profit, or where others are struggling to come good.

One argument for splitting is to introduce competition, especially when there will otherwise be a monopoly or a very limited choice of alternatives. We have experience of this happening, for instance BT being split into wholesale and retail.

The health service will become “totally dependent” on electronic health records over the next five years, health secretary Jeremy Hunt has said.

Speaking at a Cambridge Health Network event on Wednesday evening, alongside NHS England’s director of patients and information Tim Kelsey, Hunt said 2013 had been a tough year for the NHS, but he is feeling “very optimistic and very encouraged” about the strides made in terms of transparency.

He said three things will become an “absolute given” over the next five years. The first is that the health service will become totally dependent on electronic health records and people will wonder how they ever lived without them.

But with feverish activity and high valuations comes the danger of a bubble, said veteran investor Anne DeGheest, who was an investor and entrepreneur through the tech boom of the 1990s, and who founded Sand Hill Road firm HealthTech Capital several years ago.

Texas Children's Hospital has transformed its quality improvement efforts through data warehousing and analytics, according to a case study from the College of Healthcare Information Management Executives.

Reports that used to take three months now can be done in 30 minutes and real-time data displayed visually for meetings. The hospital estimates that analysis from its data warehouse costs 70 percent less than analysis directly from its electronic health record because it no longer requires IT staff to compile data from disparate systems.

Texas Children's executives estimate they have achieved about $4.5 million of direct benefits from four of its data warehousing projects.

When talking HIPAA privacy and security, the numbers do most of the talking.

Take 29.3 million, for instance, the number of patient health records compromised in a HIPAA data breach since 2009, or 138 percent, the percent jump in the number of health records breached just from 2012.

These numbers, compiled in a February 2014 breach report by healthcare IT security firm Redspin, though, don't tell the whole story, as these are numbers reported to the U.S. Department of Health and Human Services by HIPAA covered entities.

Many healthcare breaches still go unreported, industry officials point out, and many breach offenders don't make the list of shame. Moreover, breaches involving the health records of fewer than 500 individuals are not required to be publicly reported, which also skews the final numbers.

Healthcare providers face legal risks because of gaps in the national regulatory framework for mobile medical information technologies, according to a pair of articles on telehealth privacy and security in the healthcare policy journal Health Affairs this month. Patients face inadequate protections of their confidential healthcare data as well, the articles noted.

Less than 10 percent of physician practices are ready for the switch to the ICD-10 code-set, according to a new survey from the Englewood, Colo.-based Medical Group Management Association (MGMA).

The deadline for the switch to the ICD-10 code-set is Oct. 1, as mandated by the Centers for Medicare & Medicaid Services (CMS). According to research done by MGMA, which includes responses from more than 570 medical groups where more than 21,000 physicians practice, only a small percentage of the industry is ready.

Along with the lass than 10 percent that are ready for ICD-10, MGMA's research revealed that most practices need a software upgrade. More than 80 percent of respondents indicated that their practice management software would require replacement or upgrading in order to accommodate ICD-10 diagnosis codes, this is up from 73.2 percent in June, when MGMA last conducted this survey. In addition, 81.8 percent say their EHR needs to be replaced or upgraded, a jump from 65.3 percent in June.

This year promises to be a busy one on the health IT front, with increasing developments in health information exchanges, the incorporation of meaningful use Stage 2 requirements and the general push toward greater transparency in many areas of health care delivery to boost interoperability.

CCHIT surprised many in the industry this past week when it announced it would be bowing out of the EHR certification game to focus on advisory services and thought leadership. Alisa Ray, executive director and CEO of the standards and testing pioneer, spoke with Healthcare IT News about the rationale behind that decision.

A: It's a combination of things. Our board has looked at the ONC certification and testing business — and in particular the new requirements for 2014. It's been very variable, from a business perspective. So in terms of just managing operations and trying to keep a full staff synced through the peaks and valleys, it's been very hard to do.

This is our sole line of business right now, ONC testing and certification. So we're very susceptible — if there are updates in the program that slow things down for a little while, if the vendors don't come right away, then there's a lag in our revenue because we get paid by them needing testing.

Those who track the progress of health information exchanges may be excused if they follow their intuition and believe that, of all the issues the health care industry faces in tackling the task of getting the right data about the right patient to the right clinician or administrator, the basics of matching patient identity might be more or less accomplished. Obviously, you have to have the foundational data of a patient's identity down before you can start worrying about exchanging anything else.

Excused they may be, but reinforced, no. While executives of some of the nation's pioneering HIE's say they are making significant progress in building their enterprise master patient indexes, there are still plenty of instances of counterintuitive revelation that make them realize there is a long way to go before patients can be assured that, under the worst-scenario "unconscious in an ER" situation, the attending physicians and nurses will know exactly whom they are treating.

"We're trying to make the providers better at care coordination, but quite frankly, we're putting a huge burden on them," says Paul Wilder, vice president of product management at the New York eHealth Collaborative, the non-profit organization responsible for coordinating the Empire State's data exchange effort. "I know how difficult it was for me to get records successfully sent four miles as the crow flies when the records concerned me or someone close to me. Now we want people with 2,000 people on a panel to do it better? It's going to be tough without technology."

NHS England has sent directions to the Health and Social Care Information Centre to start collecting and linking primary care data to Hospital Episode Statistics. EHI news editor Rebecca Todd takes a look back at the creation of the care.data programme and the concerns many have about its implications for patient privacy.

30 January 2014

Clever use of data can help the NHS make better decisions about planning services and reducing waste, as well as devising new treatments with a direct effect on patient care.

The real 'scandal' of data use, some would argue, is the chronic underuse of the wealth of patient data locked up in various systems in order to benefit the health system as a whole.

NHS England wants to create a new national database of identifiable patient data pulled from hospitals, GPs, social care, community care and other areas. This will be stored in the ‘safe haven’ of the Health and Social Care Information Centre, where it will be linked to create new Care Episode Statistics.

A study of adult users of a national telemedicine service found that it appears to be expanding access to patients who are not connected to other providers. Its users were younger, more affluent, had no established healthcare relationships and were less likely to have a follow-up visit, according to research published at Health Affairs.

Saldaña was part of the national team of HIT experts who wrote "Improving Outcomes with Clinical Decision Support," a manual for CDS implementation.

While Texas Health Resources employs a specific vendor system for its electronic health record, Saldaña says it also has added some third-party vendors for functionalities like a drug interaction checker.

Most healthcare IT executives say they do not have the technology infrastructure in place to be fully prepared for a disaster recovery incident, according to a new report from MeriTalk, an Alexandria, Va.-based public-private partnership focused on government IT issues.

For the report, “Rx: ITaaS + Trust," Meritalk surveyed 100 health IT executives and used data from Hopkinton, Mass.-based EMC Corporation, which surveyed 283 health IT executives. The majority showed that if there was an unplanned outage, they would be ill prepared to fully handle it.

Scott Mace, for HealthLeaders Media , February 4, 2014

An electronic health record system provider is offering to equip small physicians practices with cloud-based software on a shoestring. The move is making high-end EHRs that cost tens of millions of dollars to get up and running look like dinosaurs, at least at small health systems.

One reason physicians have gravitated to mobile devices is the steep discount that phone carriers have passed along to customers to get their hands on the latest hot smartphone. Now that same trend has come to the doctor's office desktop—without the usual two-year commitment.

Practice Fusion, which for several years has given away free, web-based EHR software to small practices of 15 physicians or fewer, upped its game last month by announcing that it would make available one Chromebook per practice to anyone willing to sign up for its cloud EHR.

From patient accounting systems to sticky notes and "cheat sheets" posted in exam rooms, ICD-9 codes permeate the health care environment, translating the information in medical records to numbers on claim forms and ensuring that providers get paid for the care they give. But all those old codes have to be rooted out and replaced by October 1.

ICD-10, the next-generation code set, is really coming this time, two decades after its original development and many years after its adoption world-wide for public health research and miscellaneous other purposes. Ready or not, U.S. providers will be required to code their claims with the exponentially more complex ICD-10 codes, or not get paid by either government or private payers. The Centers for Medicare and Medicaid Services will not be backing down from the deadline as it has before.

Ask chief executive officers of provider organizations for their views on health information technology and you'll get the same answer again and again: It's all about better, accountable and patient-centered care. And that means it's all about interoperability and data.

Take a look at the ongoing and planned I.T. initiatives at a small critical access hospital in Bonham, Texas, and there isn't much difference with what's going on at an 11-hospital delivery system.

Twenty-five bed Red River Regional Hospital in Texas swapped out its core financial and clinical information systems from its incumbent community hospital vendor, and got new systems from Healthland, which CEO David Conejo says gives much better service to hospitals of all sizes below 200 beds. The previous vendor told Conejo he could spend $80,000 in upgrades to support analytics and patient-centered care, or just continue with what the hospital already has.

If you're shirking your security systems' obligations all to save a few pennies, better think again. Chances are, it will end up costing much more down the road -- a whopping $1.6 billion more.

Most healthcare organizations nationwide, some 61 percent to be exact, reported a security related incident in the form of security breach, data loss or unplanned downtime at least once this past year, according to a new health IT report by MeriTalk, a public-private organization working to improve government information technology.

These security events cost U.S. hospitals an estimated $1.6 billion each year. Breaking it down by incident, hospitals should expect to hand over on average $810,000 per security breach, which occurs at nearly one in five healthcare organizations nationwide.

Blackford Middleton, MD, first came across the term “clinical decision support” in 1983.

That’s when he was in medical school, at SUNY Buffalo, discussing health data management. “I thought that for the medical students and doctors it was ridiculous that we were carrying around clipboards to transfer data between hospital information systems,” said Middleton in a recent interview with Government nHealth IT. Today, Middleton is chief informatics officer at Vanderbilt University Health System and chair of the American Medical Informatics Association board.

Even back then, the year before Apple’s first personal computer went to market, he and his classmates thought it would be worthwhile for information systems to help clinicians with the complexity of diagnosis — and that endeavor continues.

Health IT executives aren't exactly prepared to weather any storm--most don't feel prepared for security breaches or unplanned outages, according to a new survey.

More than half (56 percent) of the survey's respondents said they would need eight hours or more to restore 100 percent of data lost in a breach. The majority of the 283 health IT executives surveyed--82 percent--said that their technology infrastructure is "not fully prepared for a disaster recovery incident."

Can healthcare IT deliver value? According to David Levin, chief medical information officer of Cleveland Clinic Health System, it can--but getting there is "going to be messy."

"A good place to begin is by remembering that health IT is a means and not an end in itself," Levin writes in Healthcare Informatics. "Sure many of us in the field love the technology, love to tinker and to dream about the next cool piece of hardware or software... But our strategic lens should be on HIT as an enabler of the delivery of high value healthcare."

Care coordination benefits achieved through the use of electronic health records depends on the cohesion of the primary care team, according to a study in Health Services Research.

Researchers administered three annual surveys to more than 500 primary care clinicians in a large integrated delivery system coinciding with the system's staggered implementation of an integrated EHR system. The researchers then used the responses to examine the effect of EHR use and team cohesion on care coordination, as indicated by timely clinician access to patient information and treatment agreement and responsibility agreement among the clinicians.

A new federal rule on the exchange of health data removes legal barriers that stop medical laboratories from providing lab test results directly to patients and their designees, such as developers of their personal health records systems. The rule preempts laws in 13 states and lifts a federal exemption effective in 26 more states.

Previously, in those 39 states, patients could receive or view their lab test results only through their physician or other authorized healthcare provider, or by their provider's leave.

In the past decade, society has witnessed the ascendancy of some astonishing leaps of technology, such as the smartphone and social media. Moreover, these innovations have contributed to an even quieter evolution taking place: the growth of the types and amounts of data.

Within the health environment, data are everywhere: clinical, financial, patient-generated and more. As organizations implement electronic health records, as new care delivery mechanisms such as accountable care organizations proliferate and as increasing demands for accountability, reliability and security must be met, health care organizations are awash in data.

That's why now is the time for health care organizations to start implementing programs of information governance.

Abstract

Summary: Patients are increasingly using new electronic tools such as personal health records and mobile applications to track details about their health, and sharing those details with their physicians. However, some physicians are reluctant to receive digital data from patients due to professional liability concerns. In Project HealthDesign, a research program funded by Robert Wood Johnson Foundation, clinical care teams tested the incorporation of patient-generated, digital information into clinical care. The research teams documented the professional liability concerns voiced by physicians and other clinicians during the study and the steps they took to manage them. The approach they took to managing these concerns could be helpful to providers seeking to engage patients in their care using technology.